Interleukin-10 rs2227307 and CXCR2 rs1126579 polymorphisms modulate the predisposition to septic shock

Despite major improvements in its treatment and diagnosis, sepsis is still a leading cause of death and admittance to the intensive care unit (ICU). Failure to identify patients at high risk of developing septic shock contributes to an increase in the sepsis burden and rapid molecular tests are currently the most promising avenue to aid in patient risk determination and therapeutic anticipation. The primary goal of this study was to evaluate the genetic susceptibility that affects sepsis outcome in 72 sepsis patients admitted to the ICU. Seven polymorphisms were genotyped in key inflammatory response genes in sepsis, including tumour necrosis factor-α, interlelukin (IL)-1β, IL-10, IL-8, Toll-like receptor 4, CXCR1 and CXCR2. The primary finding showed that patients who were homozygous for the major A allele in IL-10 rs1800896 had almost five times higher chance to develop septic shock compared to heterozygotes. Similarly, selected clinical features and CXCR2 rs1126579 single nucleotide polymorphisms modulated septic shock susceptibility without affecting survival. These data support the hypothesis that molecular testing has clinical usefulness to improve sepsis prognostic models. Therefore, enrichment of the ICU portfolio by including these biomarkers will aid in the early identification of sepsis patients who may develop septic shock.

Detecção de anticorpos anti-Paracoccidioides brasiliensis em pacientes suspeitos de tuberculose / Detection of Anti-Paracoccidioides brasiliensis antibodies in suspected tuberculosis patients

Paracoccidioidomycosis (PCM) is an important systemic mycosis in Latin America that occurs as active disease in 1-2% of Paracoccidioides brasiliensis infected people. Like PCM, tuberculosis (TB) affects mainly the lungs and the clinical and radiological aspects do not always allow differentiation between them. The aim of this study was to carry out serological investigation for detecting anti-P. brasiliensis antibodies, by three serological methods, in patients with symptoms suggestive of pulmonary TB. From August 2005 to September 2006, 76 patients with pulmonary symptoms suspected for TB were attended at the Regional Specialties Center Laboratory in the city of Paranavaí, Paraná, Brazil and submitted to microbiological TB research, ELISA, immunodiffusion and immunoblotting for PCM. Of all the individuals, 21 (27.63%) were reactive to P. brasiliensis by ELISA and 11 (14.47%) showed a laboratory diagnosis of pulmonary TB. Of all the individuals serologically reactive to P. brasiliensis, by ELISA, none had positive results by immunodiffusion and one reacted with antigen 43 kDa when Immunobloting was carried out. Our results lead us to reflect a necessity to obtain a more specific serologic test for diagnosis of PCM disease in patients with respiratory symptoms considering the high number of individuals reactive to P. brasiliensis especially in endemic areas

Paracoccidioidomicose (PCM) é importante micose sistêmica na América Latina, que ocorre como doença ativa em 1-2% dos indivíduos infectados com Paracoccidioides brasiliensis. Assim como a PCM, a tuberculose (TB) afeta principalmente os pulmões, porém os aspectos clínicos e radiológicos nem sempre permitem a diferenciação entre essas doenças. O objetivo deste estudo foi realizar um inquérito sorológico para a detecção de anticorpos anti-P. brasiliensis, utilizando três métodos sorológicos, em pacientes com sintomas sugestivos de tuberculose pulmonar. De agosto de 2005 a setembro de 2006, 76 pacientes sintomáticos foram atendidos no Laboratório do Centro Regional de Especialidades de Paranavaí, Paraná, Brasil e submetidos à investigação microbiológica para TB e de anticorpos por ELISA, imunodifusão e immunobloting para PCM. Destes, 21 (27,63%) foram reativos para P. brasiliensis por ELISA e 11 (14,47%) apresentaram diagnóstico laboratorial de tuberculose pulmonar. Dos indivíduos sorologicamente reativos para P. brasiliensis, por ELISA, nenhum apresentou resultado positivo pela técnica de imunodifusão e um reagiu com antígeno de 43 kDa quando do uso de immunobloting. Os resultados obtidos nos levam a refletir da necessidade de se obter um teste sorológico mais específico para o diagnóstico de PCM doença em pacientes com sintomas respiratórios, considerando o elevado número de indivíduos reativos para P. brasiliensis principalmente em áreas endêmicas